Information Collection

Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening

IC 250641 under ICR 202208-0920-008 · OMB 0920-1356.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening	Form and Instruction
Cognitive interview screening Attachment S_Cognitive Interview Screener.docx	Form and Instruction
Cognitive interview screening Attachment S_Cognitive Interview Screener.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Cognitive interview screening	Attachment S_Cognitive Interview Screener.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.